Department of Burns, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Center of Wound Healing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Wound Care. 2022 Oct 1;31(Sup10):S7-S15. doi: 10.12968/jowc.2022.31.Sup10.S7.
Regular retrospective analysis is necessary for potential improvement in clinical practice for the treatment of hard-to-heal wounds. Comorbidities and outcomes have demonstrated spatial and temporal diversity, emphasising the importance of updates in epidemiology. The complexity of healing hard-to-heal wounds has long been known, and so we sought evidence-based improvement on the current principles of treatment.
Demographic and clinical information of patients from the WoundCareLog database was collected. Patients who met the inclusion criteria and completed follow-up after treatment were included. Comorbidities were diagnosed and classified into eight categories based on ICD-10. We compared the demographic and aetiological characteristics between patients with and without comorbidities by t-test and Chi-squared test. The impact of comorbidities on wound healing were evaluated with a multivariate Cox model.
A total of 2163 patients met the inclusion criteria and were enrolled, of whom 37.0% were aged 61-80 years, 36.0% were aged 41-60 years and 60.8% were male. The lower extremities and buttocks were the most commonly affected areas with hard-to-heal wounds. Non-traumatic wounds accounted for 66.6% of cases, and infection, pressure and diabetes were the most common causes. Paralysis and diabetes were the most important factors which led to a prolonged healing process and inferior clinical outcomes.
Comorbidities of hard-to-heal wounds were treated as separate contributors and their weighted effect on outcome was calculated through correlation analysis. Paralysis and diabetes were the most unfavourable comorbidities affecting the treatment of non-traumatic hard-to-heal wounds. Our study highlighted the priority of comorbidity treatment through data-driven approaches. It provides potential value in developing better public health strategies and preventive medicine.
为了提高临床治疗难愈性伤口的效果，需要定期进行回顾性分析。合并症和结局表现出时空多样性，这强调了更新流行病学数据的重要性。人们早就认识到治疗难愈性伤口的复杂性，因此我们寻求基于证据的治疗方法的改进。
收集 WoundCareLog 数据库中的患者人口统计学和临床信息。纳入符合纳入标准并在治疗后完成随访的患者。根据 ICD-10 将合并症诊断并分类为 8 类。我们通过 t 检验和卡方检验比较了合并症患者和无合并症患者的人口统计学和病因特征。使用多变量 Cox 模型评估合并症对伤口愈合的影响。
共有 2163 名符合纳入标准的患者被纳入研究，其中 37.0%的患者年龄在 61-80 岁，36.0%的患者年龄在 41-60 岁，60.8%的患者为男性。下肢和臀部是最难愈合的伤口最常见的部位。非创伤性伤口占 66.6%，感染、压力和糖尿病是最常见的原因。瘫痪和糖尿病是导致愈合过程延长和临床结局较差的最重要因素。
将难愈性伤口的合并症视为单独的发病因素，并通过相关性分析计算其对结局的加权影响。瘫痪和糖尿病是影响非创伤性难愈性伤口治疗的最不利合并症。我们的研究通过数据驱动的方法强调了合并症治疗的优先级。它为制定更好的公共卫生策略和预防医学提供了潜在价值。
